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Mississippi rates for HCPCS A9515

Choline C-11 Diagnostic Per Study Dose Up To 20 Millicuries (Reinstated 01/01/2017) Supply Of Radiopharmaceutical Diagnostic Imaging Agent Technitium Tc-99m Pentetate Per Mci (Del 12/31/2005)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,920.00 / $4,920.00 / $7,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,920.00 / $7,200.00 / $7,200.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,670.00 / $5,670.00 / $6,237.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,400.00 / $5,400.00 / $5,400.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,475.53 / $5,100.00 / $5,100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,800.00 / $5,000.00 / $6,500.00